Old Age Homes

Recently someone asked me to pen down a few thoughts on why I thought that the welfarist approach to development is wrong and why I advocate a Rights-based Approach to Development. The conclusion is not totally correct as I believe there is a place for welfare-oriented activities, particularly where they would otherwise be left out completely. Or when a new initiative or intervention is being piloted and expertise on the subject is limited. But generally not otherwise.

Historically charitable organisations/Voluntary organisations/NGOs, by whatever name called have been carrying out what may be called classical welfare activities. Examples would be orphanages, old age homes, hospitals, clinics, or schools/ very often, though not always, the motivation has been religion. For instance, the Sikhs are known for hospitality and langars, Christians for schools and hospitals, and so on.

Welfare activities are easily funded because of their high visibility and also because they are easily measurable, so also it is popular. Easy to count how many clinics and hospitals were set up, how many patients came for treatment, how many got their eyesight back after cataract surgery, how many babies were immunised, and how many disabled people were given wheelchairs and thus got their mobility back and so on in other fields. Nearly the whole of Corporate Social Responsibility funding is given over to such projects as the outcome is immediately visible and looks good in annual reports during submissions to to the Ministry of Corporate Affairs. Difficult to measure the impact of work that may have gone into preventing encounter killings or deaths in police custody or creating an environment of communal harmony and amity. The government doesn’t want to hear about such things, maybe doesn’t even want some of the things to be done, donors are therefore often wary of funding such research or advocacy work, and finally, the impact is not easily captured in an evaluation.

There is an issue with this welfarist approach. These approaches were very necessary in the colonial times and before when governments usually did not invest in these things and private schools, hospitals and orphanages were all that were available. Post-independence, The Directive Principles of State Policy, enshrined in Part IV of the Indian Constitution reflects that India is a welfare state and mandates the state to look after the welfare of its citizens. The Constitution guarantees the Right to Life under Article 21 and although the Article does not expand on this, there are several Supreme Court judgments that have elaborated that the Right to Life is not just the Right to Breathe but a lot more things.

Subsequently, several welfare state-oriented laws have been passed looking into food security, employment, education, disability, gender equity, child protection, employment and health, and senior citizen among many others. The State does not just pass laws but collects taxes – direct and indirect to have the money to provide these services. Getting a good education, health care, employment opportunities, law and order, pensions, and other aid in old age is not just promised to Indian citizens but we pay taxes for the same and have a right to expect them. These rights are enforceable in court and have been several times.

In this day and time, civil society and NGOs ought to be holding the government accountable for providing these services through social audits, public hearings, and other people-centric mechanisms instead of providing them themselves. Every time an NGO pays the tuition fees of a child or provides new furniture to a classroom, or installs a toilet, it does a job that the government is required and meant to do and now won’t because an NGO has done for them. I have seen this myself and NGOs like the one I was working for then were derisively called contractor NGOs who would easily get their FCRA because they were doing proxy work for the government by building toilets, rural roads, water storage tanks, running grain banks and the like.

Besides an NGO running a hospital or a school for altruistic motives is just a short walk away from their total privatisation and commercialisation as we are witnessing in education and health care in particular. NGOs used to install hand pumps in rural India. Today corporate houses run water ATMs, charge, and make profits. The more voluntary organisations undertake welfarist work themselves, the more they encourage the government to abdicate their responsibility in that area and use the money for other purposes, possibly to buy arms and equipment or increase citizen surveillance cameras or modernise prisons something like that.

This is not to say that welfarist work on the part of NGOs is totally unnecessary. This piece is written with India in mind and the framework of the Indian Constitution. There are many places where mechanisms of governance do not exist or have collapsed – warn torn or chronically civil war-ridden countries – South Sudan comes to mind where the government is weak and lacks capacity and expertise. Possibly Afghanistan. In those places NGOs need to do what needs doing, possibly doing welfare work themselves. Groups like the World Food Programme and Médecins Sans Frontières, to name just a few do immeasurably good work in conflict zones and areas where governance has collapsed.

However to take a cue from the developed world, models, NGOs there are usually not doing pure welfare work in their home countries because that aspect is largely taken care of by the governments, although the civil society there continues to play a watchdog role. They may occasionally play a more active role, particularly stepping into the breaches and gaps where the policy domain is grey – for example refugees, asylum seekers, and other displaced. Even there, more often than not, they are not merely running shelter homes, they are actively pursuing human rights dogma and advocating for refugee rights, racially and ethnically inclusive communities, and such.

In summary, rights-based approaches are about empowering people to know and claim their rights and increasing the ability and accountability of individuals and institutions who are responsible for respecting, protecting, and fulfilling rights. The welfarist approach is paternalistic and established an unequal equation between the donor and the recipient which is disempowering at best and humiliating at its worst.

Dr Shantanu Dutta , a former Air Force doctor is now serving in the NGO sector for the last few decades.


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